From the Guidelines
Effective seizure management in cerebral palsy patients requires a comprehensive approach focusing on medication adherence, recognition of seizure triggers, and appropriate emergency response, with first-line antiepileptic medications including levetiracetam, valproic acid, or lamotrigine, as recommended by recent guidelines 1.
Key Considerations
- Medication regimens should be individualized based on seizure type, comorbidities, and potential drug interactions, taking into account the patient's specific needs and medical history.
- Patients and caregivers should maintain a seizure diary documenting frequency, duration, and potential triggers such as missed medications, sleep deprivation, illness, or stress, to better understand and manage seizure patterns.
- Emergency protocols should include proper positioning (side-lying), timing seizures (call emergency services if lasting >5 minutes), and administration of rescue medications like rectal diazepam (0.2-0.5 mg/kg) or buccal midazolam (0.2-0.5 mg/kg) for prolonged seizures, as outlined in recent clinical policies 1.
Seizure Management Principles
- Regular monitoring of drug levels, liver function, and complete blood counts is essential for patients on certain antiepileptics, to minimize potential side effects and ensure optimal treatment outcomes.
- Addressing comorbid conditions like spasticity, sleep disorders, and gastrointestinal issues can improve seizure control, as these conditions may lower seizure threshold or interfere with medication absorption, highlighting the importance of a multidisciplinary approach to care.
- The most recent guidelines emphasize the importance of individualized treatment plans, considering factors such as seizure type, frequency, and patient-specific needs, as well as the potential risks and benefits of different treatment options 1.
Treatment Recommendations
- For patients with cerebral palsy and epilepsy, monotherapy with any of the standard antiepileptic drugs (carbamazepine, phenobarbital, phenytoin, and valproic acid) should be offered, with phenobarbital as a first option if availability can be assured, as recommended by the WHO guidelines 1.
- Women with epilepsy should have seizures controlled as well as possible with antiepileptic drug monotherapy at minimum effective dose, with valproic acid avoided if possible, and folic acid routinely taken when on antiepileptic drugs, to minimize potential risks and optimize treatment outcomes 1.
From the Research
Key Teaching Points for Seizure Management in Cerebral Palsy
- The management of seizures in patients with cerebral palsy requires a comprehensive approach, considering the patient's overall health and rehabilitation needs 2.
- Antiepileptic drugs (AEDs) are the primary treatment for seizures, and the choice of medication depends on the type of seizure and the patient's individual needs 3, 4.
- Monotherapy is often the preferred initial treatment approach, with the goal of achieving seizure control with a single medication 4, 5.
- Levetiracetam has been shown to be an effective AED in children and adolescents with hemiplegic cerebral palsy and infrequent but persistent focal seizures 3.
- The selection of AEDs should be based on the patient's specific needs and medical history, taking into account potential side effects and interactions with other medications 4, 5.
- Rehabilitation measures should not be discontinued in patients with cerebral palsy and epilepsy, but rather adjusted to accommodate the patient's antiepileptic treatment regimen 2.
- The risk of recurrent seizures should guide the use of AEDs, and treatment should be individualized based on the patient's risk factors and medical history 5.
- Alternative treatments, such as surgical resection of the seizure focus, ketogenic diets, vagus nerve stimulators, and implantable brain neurostimulators, may be considered for patients with seizures that are not controlled with AEDs 5.